Mohammad Iqbal Hussain1, Jonty Bird2, Mohammed Hamid2, Chaminda Sellahewa2
1Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom. 2Dudley Group NHS Foundation Trust, Dudley, United Kingdom
Abstract
Introduction: The COVID-19 pandemic has created a backlog of around 7 million patients waiting for an operation in NHS England. A significant proportion of the waiting list included patients waiting for Laparoscopic Cholecystectomy. This is partly due to a lack of awareness and intent leading to non-compliance with the Hot Gall Bladder Pathway.
Methods: A twice-weekly Same Day Emergency Care (SDEC) service aimed at reducing the burden of gallstone disease was initiated in our hospital. This study evaluated a consecutive series of hot laparoscopic cholecystectomies performed between December 2021 and January 2023. Statistical analysis was performed using Statistical Package for Social Science (SPSS) version 27.0 for Windows (SPSS Inc., Chicago, IL, USA).
Results: Overall, 264 (females: 189, males: 75) hot cholecystectomies were performed with a median age of 47 years. The median BMI and ASA were 32 and 2 respectively. 210 patients presented for the first time. 139 patients had Grade I while 90 patients had Grade II acute cholecystitis as per Tokyo Guidelines 2018. All cases were completed laparoscopically. 29 patients had a subtotal cholecystectomy. Patients with Tokyo Grade II had 6.9 times higher odds of subtotal cholecystectomy than Grade I. Median postoperative stay was zero. 49 patients encountered complications (Clavien-Dindo Grade I: 17; Grade II: 9; Grade III: 23). Increased BMI was linked to an increased risk of complications.
Conclusions: The dedicated SDEC service for hot cholecystectomies can be employed to resolve the mounting waiting lists in NHS England while at the same time providing high-quality care.